Review Articles

In this Review, Emmert and colleagues provide an overview of the clinically available metallic and polymeric stents used to treat coronary artery disease and valvular heart disease, and discuss the manufacturing techniques used to fabricate these stents, with a focus on the emerging role of 3D-printing technologies.

Myocarditis is an aetiologically diverse condition, associated with substantial morbidity and mortality worldwide. In this Review, Klingel et al. synthesize epidemiological insights across age groups and geographical regions, and discuss variability in diagnostics and management, with a particular emphasis on the underdiagnosed disease burden in low-resource settings.

Drug-coated balloons (DCBs) are used for the treatment of both coronary and peripheral artery disease. In this Review, Byrne and colleagues describe the device design and mechanism of action of DCBs, the scientific and clinical trial evidence for DCB angioplasty and important procedural considerations for successful DCB use.

In this Review, Aimo and colleagues provide an overview of the effects of microplastics and nanoplastics (MNPs) on cardiovascular health and evaluate the potential mechanisms linking MNPs to cardiovascular disease, including inflammation, oxidative stress and mitochondrial dysfunction.

In this Review, De Blasio and Ritchie describe the inflammatory pathways involved in the pathogenesis of diabetic cardiomyopathy and discuss potential strategies to target inflammation in this condition.

In this Review, Brakenhielm summarizes current knowledge on cardiac lymphatics, including structural and molecular features of the lymphatic system, the regulation of cardiac lymphangiogenesis, the lymphatic-mediated modulation of immunity and inflammation, and the alterations in cardiovascular diseases, and discusses potential approaches for therapeutic lymphangiogenesis as well as areas for future research.

Antiphospholipid antibodies (aPL) are associated with an elevated risk of thromboembolic events in patients with antiphospholipid syndrome and, increasingly, in those without previous thrombosis. In this Review, Bikdeli and colleagues discuss the clinical relevance of aPL seropositivity in predicting the risk of thrombotic cardiovascular events, summarize potential management strategies and identify key knowledge gaps that warrant further research.

Atrial failure is an emerging clinical syndrome that results from an underlying atrial cardiomyopathy and manifests with clinical symptoms. In this Review, Baranchuk and colleagues detail the pathophysiological mechanisms, clinical phenotypes and multimodality imaging of atrial failure as well as emerging therapeutic strategies to reverse atrial remodelling.

Schiattarella and colleagues propose a framework linking heart failure with preserved ejection fraction and metabolic dysfunction-associated steatotic liver disease as interconnected syndromes rather than coincidental comorbidities. The authors delineate shared metabolic, inflammatory and endocrine drivers and propose a shift towards coordinated strategies and integrated clinical algorithms to improve prevention, risk stratification, early detection and co-management of these disorders.

As the indications for T cell immunotherapies, particularly chimeric antigen receptor T cell therapy, continue to expand, a nuanced understanding of their potential adverse effects is required. In this Review, Raddatz and colleagues summarize the mechanisms, epidemiology and management of T cell therapy-associated cytokine release syndrome and subsequent cardiotoxicity.

The clinical management of patients with non-acute myocardial ischaemic syndrome (NAMIS) continues to evolve as increasingly effective treatment approaches become available. In this Review, Chiu et al. summarize the evidence from randomized trials on optimal medical therapy with or without percutaneous coronary intervention or coronary artery bypass graft surgery to guide shared decision making in patients with NAMIS.

The ageing process leads to cellular changes that disrupt the intricate axis between the nervous and vascular systems that governs cardiac function. In this Review, Wagner and Dimmeler describe the crucial role of neurovascular ageing in cardiac dysfunction and explore the therapeutic potential of targeting the cardiac neurovascular unit to develop interventions for ageing populations.

In this Review, Khosravi and Radisic highlight the use of heart-on-a-chip and vasculature-on-a-chip platforms consisting of 3D structures that incorporate relevant cell populations to model cardiovascular disease phenotypes and contribute to the development of novel therapeutics.

Family history of premature coronary artery disease is a well-recognized, but under-recorded, risk factor that captures the complex interplay among shared genetic, environmental and lifestyle factors within families. Here, Lan et al. review the mechanisms of inherited risk, discuss the current limitations of family history in risk stratification models and outline future directions for precision care in families with a history of premature coronary artery disease.

The environmental exposome, which includes pollution, contamination, climate and social determinants of health, is intricately involved in the pathophysiology of heart failure. In this Review, Hahad and colleagues explore the complex relationship between environmental stressors and heart failure, advocating for their inclusion alongside traditional risk factors and highlighting the need for new strategies to address the effects of the exposome on public health.

In this Review, Galli and colleagues discuss the mechanisms and associated biomarkers of traditional and emerging factors responsible for the residual risk of recurrent adverse cardiovascular events in patients with coronary artery disease, with a focus on new pathophysiological insights and the therapeutic implications.

In this Review, Ferrucci and colleagues propose that inflammation is a resilience mechanism that resolves molecular and cellular damage driven by environmental stressors. With ageing, however, this protective response can become dysregulated and maladaptive, promoting collateral changes central to the pathophysiology of cardiovascular disease.

In this Review, Kaiser and Nicolai summarize our understanding of procoagulant platelets, describing the signalling pathways that control platelet procoagulant activation and discussing the role of procoagulant platelets in venous and arterial thrombosis, as well as potential therapeutic approaches to target these platelets in thrombotic and thromboinflammatory disorders, including cardiovascular disease, septic inflammation and immune complex-mediated diseases.

Frailty is common in older individuals, but can occur independently of advanced age, multimorbidity or disability. In this Review, Nguyen and colleagues draw on evidence from clinical guidelines and randomized controlled trials to provide an in-depth discussion of the unique challenges associated with cardiovascular pharmacotherapy in older patients with frailty.

In this Review, Laurette and Gilsbach summarize the current knowledge on the cardiac epigenome, including the dynamic changes in DNA methylation, histone modifications and chromatin accessibility in cardiomyocytes during development and disease. They also describe the interplay between cell type-specific mechanisms and discuss the translational potential of targeting epigenetic mechanisms for the prevention and treatment of cardiac diseases.